Advanced defibrillator are utilized to provide a variety of patient monitoring and therapy deliveries. More particularly, advanced defibrillators incorporate patient monitoring capabilities including, but not limited to, electrocardiogram (“ECG”), heart rate, pulse rate, pulse oximetry (“SpO2”), exhaled (end tidal) carbon dioxide (“EtCO2”), non-invasive blood pressure (“NIBP”), invasive blood pressure (“IBP”), respiratory rate and temperature. The monitoring capabilities of advanced defibrillators may be displayed in numeric values (e.g., heart rate in beats-per-minute) and/or time-varying waveforms (e.g., ECG waves) and/or alarms (e.g. heart rate too high).
Advanced defibrillators further incorporate electrical therapy delivery capabilities including, but not limited to manual defibrillation, automated external defibrillation (“AED”), synchronized cardioversion, transcutaneous pacing and support for cardiopulmonary resuscitation (“CPR”). The therapy delivery capabilities of advanced defibrillators may be displayed as a selected energy dosage, a delivered energy dosage, a number of delivered shocks or pacing rate and pacing output current.
In the field, this full array of patient monitoring and therapy delivery capabilities is not needed for every clinical situation. In fact, an advanced defibrillator would be more difficult to utilize effectively if all patient monitoring and therapy delivery capabilities were always available simultaneously. For example, the display screen would become cluttered with irrelevant distracting information if control and status information related to pacing were displayed when the device is used to deliver a defibrillation shock. Thus, a current practice for advanced defibrillators is to incorporate modes of operation that make available pre-selected subsets of patient monitoring and therapy delivery capabilities. The following is a description of five (5) typical clinical operation modes.
Manual Defibrillation.
This operation mode is utilized to deliver a defibrillation shock for ventricular fibrillation (i.e. sudden cardiac arrest). In support of the defibrillation shock, key patient parameters being monitored include ECG, SpO2 and EtCO2. Additionally, a control interface enables an energy dose selection and charging of the advanced defibrillator for shocking, and a display illustrates control/status information related to delivering the defibrillation shock including a selected energy dose, a delivered energy dose, and a number of shocks delivered. CPR coaching (e.g. depth and rate of compressions) might also be available be displayed or verbally communicated.
Synchronized Cardioversion.
This operation mode is utilize to deliver a synchronized shock for arrhythmias such as atrial fibrillation. In support of the synchronized shock, key patient parameters being monitored include ECG, SpO2, NIBP and EtCO2. Additionally, a control interface enables an energy dose selection, and the display illustrates control/status information related to delivering the synchronized shock including a selected energy dose, a delivered energy dose, and a number of shocks delivered. CPR coaching information is not needed because the patient is conscious.
Automated External Defibrillation (“AED”).
This operation mode is utilized by caregivers with Basic Life Support training (lower skill level than users with Advanced Life support training) to deliver a defibrillation shock, and therefore includes an automatic ECG analysis to determine whether a shock is advised and provides user prompts and graphics to guide the user through the steps of attaching pads, and shocking if needed. Patient monitoring is typically limited to ECG and SpO2 to avoid confusion for the less skilled caregiver. Additionally, the control interface provides for initiating the automatic shock advisory determination and for shocking, and the display illustrates control/status information related to delivering shocks including the delivered energy dose, and the number of shocks delivered is displayed. CPR coaching is also available.
Pacing.
This operation mode is utilized to deliver external pacing pulses for conditions including bradycardia. In support of the pacing pulses, key patient parameters monitored include ECG, SpO2, NIBP and EtCO2. The control interface provides for setting up the pacing, and the display illustrates control/status information related to delivering pace pulses including a pacing rate and a pacing output current, a delivered energy dose and a number of pluses delivered.
Patient Monitoring.
This operation mode is utilized to monitor the patient when electrical therapy delivery is not known to be needed. Includes all monitoring functions. May also include advanced monitoring functions such as diagnostic 12-lead ECG analysis for diagnosis of myocardial infarction (heart attack). Does not provide controls or display information related to therapy delivery, so the entire display screen is available for displaying monitored parameters.
Advanced monitor/defibrillators do not provide capabilities for clinicians or clinical institutions to define other operation modes. However, there are means to customize or adapt the clinical operating modes by pre-configuring various settings related to the appearance of the user interface, how measurements and alarms behave, and how therapy is delivered. For example, high and low alarm limits can be set for heart rate for both adult and pediatric patients, the color of the SpO2 value and its associated pleth wave can be set, and therapy profile such as the default defibrillation shock energy dosage for adults can be set.
Advanced monitor/defibrillators also provide means to modify, during clinical usage, various settings related to therapy delivery, monitoring and the user interface. For example alarm limits can be adjusted for a particular patient, or a monitored parameter (e.g. SpO2) can be enabled or disabled. Additional patient-specific information can also be set during clinical usage including patient demographic data (e.g. name, patient ID, age, gender, etc), whether the patient has an internal pacemaker, etc.
In contrast to the configuration capabilities provided by advanced monitor defibrillators, some advanced patient monitoring devices, such as the Philips IntelliVue Mx800, provide profiles as a more flexible means to adapt the monitor. This profile includes user interface profile and screen layouts, monitoring profile, and monitor settings. Users can select which a profile to use for a particular clinical situation. In effect, instead of providing a limited number of pre-defined monitoring modes, the profile allows the clinician or clinical institution to create clinical monitoring modes adapted to specific patient conditions.